Cost Of Surveillance Research Articles

Know your tuberculosis epidemic-Is it time to add Mycobacterium tuberculosis immunoreactivity back into global surveillance?

Tuberculosis (TB) still causes 1.5 million deaths globally each year. Over recent decades, slow and uneven declines in TB incidence have resulted in a falling prevalence of TB disease, which increasingly concentrates in vulnerable populations. Falling prevalence, while welcome, poses new challenges for TB surveillance. Cross-sectional disease surveys require very large sample sizes to accurately estimate disease burden, and even more participants to detect trends over time or identify high-risk areas or populations, making them prohibitively resource-intensive. In the past, tuberculin skin surveys measuring Mycobacterium tuberculosis (Mtb) immunoreactivity were widely used to monitor TB epidemiology in high-incidence settings, but were limited by challenges with both delivering and interpreting the test. Here we argue that the shifting epidemiology of tuberculosis, and the development of new tests for Mtb infection, make it timely and important to revisit the strategy of TB surveillance based on infection or immunoreactivity. Mtb infection surveys carry their own operational challenges and fundamental questions, for example: around survey design and frequency; which groups should be included; how the prevalence of immunoreactivity in a population should be used to estimate force of infection; how individual results should be interpreted and managed; and how surveillance can be delivered efficiently and ethically. However, if these knowledge gaps are addressed, the relative feasibility and lower costs of Mtb infection surveillance offer a powerful and affordable opportunity to better "know your TB epidemic", understand trends, identify high-risk and underserved communities, and tailor public health responses to dynamic epidemiology.

Examining patient perspectives on sarcoma surveillance: The Sarcoma Surveillance Survey

ObjectivesThe optimal frequency and modality of sarcoma surveillance imaging are uncertain, and current practices vary substantially. While efforts to develop evidence-based guidelines are ongoing, patient perspectives regarding surveillance imaging have not been reported. The primary goal of this study was to pilot the novel Sarcoma Surveillance Survey to assess patient concerns regarding sarcoma surveillance. MethodsIn this single-center, cross-sectional study, patients receiving surveillance imaging after surgical sarcoma treatment were administered the 10-item Sarcoma Surveillance Survey, the validated Appraisal Scale, measuring positive and negative emotional reactions to imaging, and the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety Short Form 8a as a measure of anxiety. ResultsPatients expressed highest levels of concern about cost and radiation exposure associated with surveillance, and most (87.6%) did not express a preference for more or less frequent imaging. Younger patients and those living further away from the imaging center were more concerned about cost of surveillance. Female patients had higher levels of concern compared to males regarding radiation, IV contrast, and overall levels of concern about surveillance. Higher levels of anxiety were correlated with preference for more frequent imaging (rs = 0.274, p = 0.027) and higher overall level of concern about surveillance (rs = 0.259, p = 0.037). Higher negative appraisal scores were also correlated with higher overall concerns (rs = 0.323; p = 0.012). ConclusionsPatient perspectives should be considered when developing sarcoma surveillance strategies. Identifying patients with greater anxiety and concerns regarding imaging may create opportunities for improved surveillance practices as well as counseling and survivorship interventions.

Risk score-based substratification improves surveillance costs after transurethral resection of bladder tumor in patients with primary high-risk non-muscle-invasive bladder cancer

High-risk non-muscle-invasive bladder cancer (NMIBC) has a heterogeneity and intensive surveillances after transurethral resection of bladder tumor (TURBT) are major factors of increased costs. Therefore, we aimed to develop optimized surveillance protocols based on the risk score-based substratifications to improve surveillance costs. We retrospectively evaluated 428 patients with primary high-risk NMIBC who underwent TURBT. Patients were substratified into intra-lower, intra-intermediate, and intra-higher groups or UUT-lower, UUT-intermediate, and UUT-higher groups by summing each of the independent risk factors of intravesical and UUT recurrences, respectively. The optimized surveillance protocols that enhance cost-effectiveness were then developed using real incidences of recurrence after TURBT. The 10-year total surveillance costs were compared between the European Association of Urology (EAU) guidelines-based and optimized surveillance protocols. The Kaplan–Meier curves of intravesical and UUT recurrence-free survivals were clearly separated among the substratified groups. The optimized surveillance protocols promoted a 43% reduction ($487,599) in the 10-year total surveillance cost compared to the EAU guidelines-based surveillance protocol. These results suggest that the optimized surveillance protocols based on risk score-based substratifications could potentially reduce over investigation and improve surveillance costs after TURBT in patients with primary high-risk NMIBC.

Non-Invasive Sampling in the Aspect of African Swine Fever Detection-A Risk to Accurate Diagnosis.

African swine fever remains one of the most economically important and dangerous diseases of the Suidae family. Until now, neither a safe vaccine nor a treatment against ASF has been available, which is why prevention of the disease involves biosecurity measures and early recognition based on accurate diagnosis. Nowadays, different strategies for ASF detection are discussed to reduce both animal suffering and the costs of ASF surveillance. This article aims to indicate the risk, with regard to non-invasive sampling, for the detection of ASFV. In this study, we analyzed data from three independent animal trials, in the framework of the detection of positive samples in different matrices (blood, sera, oral and rectal swabs) collected from nineteen domestic pigs infected with similar doses but under different scenarios, including different ASFV strains or routes of infection. Genetic material of ASFV was found in all matrices, but detection occurred earlier in the blood samples than in the oral and the rectal swabs. Furthermore, analyses revealed that at relevant sampling timepoints, PCR-positive blood samples were detected more frequently and reached higher percentages (up to 100% during fever) than oral and rectal swabs. Moreover, mean Ct values in blood samples collected from animals infected with virulent strains were significantly lower than in oral and rectal swabs, ensuring a higher probability of ASFV detection. High Ct values and occasional shedding in all tested matrices, in the cases of animals infected by an attenuated ASFV-strain, showed that blood sampling may be necessary to confirm the presence of anti-ASFV antibodies in sera. This study showed that during veterinary surveillance, blood sampling (for both PCR and serological analyses) is essential for the accurate diagnosis of ASF and provides the highest probability of detection of the disease.

Comparison of the medical costs between active surveillance and other treatments for early prostate cancer in Japan using data from the PRIAS-JAPAN study.

To compare the medical costs of active surveillance with those of robot-assisted laparoscopic prostatectomy, brachytherapy, intensity-modulated radiation therapy, and hormone therapy for low-risk prostate cancer. The costs of protocol biopsies performed in the first year of surveillance (between January 2010 and June 2020) and those of brachytherapy and radiation therapy performed between May 2019 and June 2020 at the Kagawa University Hospital were analyzed. Hormone therapy costs were assumed to be the costs of luteinizing hormone-releasing hormone analogs for over 5 years. Active surveillance-eligible patients were defined based on the following: age <74 years, ≤T2, Gleason score ≤6, prostate-specific antigen level ≤10 ng/ml, and 1-2 positive cores. We estimated the total number of active surveillance-eligible patients in Japan based on the Japan Study Group of Prostate Cancer (J-CAP) study and the 2017 cancer statistical data. We then calculated the 5-year treatment costs of active surveillance-eligible patients using the J-CAP and PRIAS-JAPAN study data. In 2017, number of active surveillance-eligible patients in Japan was estimated to be 2808. The 5-year total costs of surveillance, prostatectomy, brachytherapy, radiation therapy, and hormone therapy were 1.65, 14.0, 4.61, 4.04, and 5.87 million United States dollar (USD), respectively. If 50% and 100% of the patients in each treatment group had opted for active surveillance as the initial treatment, the total treatment cost would have been reduced by USD 6.89 million (JPY 889 million) and USD 13.8 million (JPY 1.78 billion), respectively. Expanding active surveillance to eligible patients with prostate cancer helps save medical costs.

Cost analysis of a watch-and-wait approach in patients with a complete clinical response to chemoradiotherapy for rectal cancer.

There is increasing interest in the watch-and-wait approach for patients with rectal cancer who have had a complete clinical response following neoadjuvant long course chemoradiotherapy. This study is a cost analysis of expenditure on patients in the watch-and-wait program versus patients who underwent standard rectal resection followed by routine surveillance. Data were prospectively collated and retrospectively analysed in all patients who presented with rectal cancer from January 2016 to January 2018 at Sir Charles Gairdner Hospital, Perth, Western Australia. Software developed by the North Metropolitan Health Service was used to capture comprehensive data to calculate the in-hospital expenditure for an individual patient throughout their treatment journey. For a patient enrolled in the watch-and-wait pathway, the total cost of surveillance over a 5-year period was $45 246. This was compared with the cost of an ultra-low anterior resection/loop ileostomy/closure of loop and routine postoperative surveillance which came to a total of $87 473. While a patient who had an abdominoperineal resection followed by routine 5-year surveillance had an expenditure of $82 290. There is growing evidence that the watch-and-wait strategy is a valid management option. In the cost-conscious environment of the current health care system, the watch-and-wait pathway is a cost-effective and economically advantage treatment.

Active surveillance in small renal masses

Active surveillance is one of the options available for management of renal masses smaller than 4 cm with a suspicion of malignancy in association with nephrectomy and ablative procedures. In general, small renal masses grow slowly and have a very low metastatic potential, but exceptions occur. Active surveillance is generally offered in the elderly with high comorbidities but there is a lack of validated data in other patient demographics. Data from younger and healthier patients are gradually emerging and have shown promising results but still require further validation. Computed tomography (CT), magnetic resonance imagin (MRI), and ultrasonography (US) are all acceptable imaging modalities for surveillance of renal masses, but CT is the most commonly used. Intervals of surveillance differs from study to study, but the most common schedule is 3, 6, and 12 months after initiation, then annually. The cut off point for delayed intervention is growth &gt; 0.5 cm/year or absolute size &gt; 4 cm. Oncologic outcome is comparable to nephrectomy and ablation in terms of cancer-specific survival. Quality of life for patients undergoing active surveillance is also comparable but is significantly lower in those with confirmed malignant biopsy results. Cost of active surveillance is as a rule more cost effective than nephrectomy or ablation.

Human and Economic Cost of Disease Burden Due to Congenital Hypothyroidism in India: Too Little, but Not Too Late.

BackgroundCongenital hypothyroidism (CH) is one of the most common preventable causes of mental retardation. Implementing newborn screening (NBS) in >52 countries enabled early detection and to initiate treatment of neonates with CH. India is yet to implement a national NBS program even though an estimated 5–15% of sick newborns suffer from genetic and metabolic disorders. Recent pilot studies confirm that the CH incidence rates range from 1 in 500 to 1 in 3,400 live births. Our objective was to estimate overall incidence rates of congenital hypothyroidism and to evaluate the costs and benefits of implementing universal NBS for CH in India.MethodsWe used the best available epidemiological and cost data to synthesize incidence rates and screening costs for CH in India. We conducted a meta-analysis of country-specific published literature and included 14 studies to calculate baseline CH incidence rates. We used two models to estimate intellectual disability in unscreened cohorts. Disability-adjusted life years (DALY) were calculated to quantify burden of disease utilizing disability weights. Direct costs including screening, confirmatory tests, and treatment costs were obtained from public and private market sources. Economic benefits were calculated from lost DALY using human capital approach and value of statistical life methods, utilizing gross national income (GNI) per capita data and value of statistical life year (VSLY), respectively. Cost discounting was used to estimate the present value of future benefits over lifetime of affected newborns.ResultsThe incidence rate of CH in India is 72 (95% CI: 58, 85) cases per 100,000 live births. Based on this data, 1 in 1,388 (95% CI: 1166, 1714) infants were diagnosed with CH in India for the year 2018. The estimated annual incidence ranged from 14,000 to 20,730 cases, and those at risk for intellectual disability ranged from 5,397 to 13,929 cases. Estimated discounted and undiscounted lost DALYs were 57,640 and 410,000, respectively. Direct annual costs for universal screening for CH in India is around USD187 million. Based on current incidence and expected severity of sequelae, economic losses ranged from USD 159 million to 1.1 billion. Benefit–cost ratios ranged from 1.8 to 6.ConclusionsUniversal NBS for CH is one of the healthcare interventions that is beneficial to prevent morbidity and cost saving. The cumulative economic benefits, derived from prevention of intellectual disability, assuming cost effectiveness threshold of three times of gross domestic product per capita, far outweigh the direct and indirect costs of screening, treatment, and surveillance throughout the life of the affected individuals. Our analysis strongly supports the argument for investing in NBS that provides good value for money and would yield substantial financial gains for the country.

Image DePO: Towards Gradual Decentralization of Online Social Networks using Decentralized Privacy Overlays

Centralized online social networks --- e.g., Facebook, Twitter and TikTok --- help drive social connection on the Internet, but have nigh unfettered access to monitor and monetize the personal data of their users. This centralization can especially undermine the use of the social internet by minority populations, who disproportionately bear the costs of institutional surveillance. We introduce a new class of privacy-enhancing technology --- decentralized privacy overlays (DePOs) --- that helps cOSN users regain some control over their personal data by allowing them to selectively share secret content on cOSNs through decentralized content distribution networks. As a first step, we present an implementation and user evaluation of Image DePO, a proof-of-concept design probe that allows users to upload and share secret photos on Facebook through the Interplanetary File System peer-to-peer protocol. We qualitatively evaluated Image DePO in a controlled, test environment with 19 queer and Black, Indigenous, (and) Person of Color (BIPOC) participants. We found that while Image DePO could help address the institutional threats with which our participants expressed concern, interpersonal threats were the more salient concern in their decisions to share content. Accordingly, we argue that in order to see widespread use, DePOs must align protection against abstract institutional threats with protection against the more salient interpersonal threats users consider when making specific sharing decisions.

Patterns in the Management of Low-Grade Non–Muscle-Invasive Bladder Cancer—the Human and Economic Costs of Excessive Surveillance

Patterns in the Management of Low-Grade Non–Muscle-Invasive Bladder Cancer—the Human and Economic Costs of Excessive Surveillance

48 Cost benefit analysis for use of gbs pcr kit in pregnant patient to manage of early onset group-b streptococcus septicemia in neonates

Introduction: The incidence of EOGBS sepsis in the British isles is 0.5/1000 and is the most common cause of admission for neonatal sepsis. In term asymptomatic women, 5000 women have to be treated to prevent one case of EOGBS. Methods and study design: The purpose of the study is to find GBS colonization rate for year 2016 and 2017, incidence of EOGBS sepsis in the neonates in the University Maternity Hospital in Limerick (UMHL) and the cost benefit analysis for use of GBS DNA PCR kit. So that only those women who have current GBS would be treated and save all the surveillance tests, antibiotics and costs.

Management, surveillance patterns, and costs associated with low-grade papillary (Ta) nonmuscle-invasive bladder cancer.

464 Background: Low-risk non-muscle invasive bladder cancer (NMIBC) is associated with extremely low rates of progression and cancer-specific mortality, however, these patients may often receive non-guideline recommended and potentially costly surveillance and treatment(s). We sought to describe current surveillance and treatment practices, oncologic outcomes, and cost of care for low-grade papillary (LG Ta) NMIBC and identify predictors of increased cost of care. Methods: This population-based cohort study identified 13,054 patients diagnosed with LG Ta tumors in the Surveillance, Epidemiology and End Results-Medicare linked database from January 1, 2004 through December 31, 2013. The primary outcome was to characterize trends in population-level surveillance and treatment practice patterns over time among LG Ta patients. The secondary outcomes were recurrence, progression, and costs of care. Results: Of the 13,054 patients who met inclusion criteria, 9,596 (73.5%) were male and 3,485 (26.5%) were female, with a median age of 76 (Interquartile Range (IQR): 71–81) years. Rates of surveillance cystoscopy increased over the study period (79.3% to 81.5%, p = 0.007) with patients undergoing a median of three cystoscopies per year (IQR: 2–4). Rates of upper tract imaging utilization also increased, namely the use of computed tomography (CT) or magnetic resonance imaging (MRI) (30.4% to 47%, p &lt; 0.001), with most patients undergoing a median of two imaging tests per year. Similarly, the use of urine cytology or other urine biomarkers also increased (44.8% to 54.9%, p &lt; 0.001). Rates of compliance with current guidelines decreased over time suggesting overutilization of all surveillance testing modalities. A total of 17.2% of patients received intravesical bacillus-Calmette Guerin (BCG) and 6.1% received intravesical chemotherapy (excluding single perioperative dose). Among all LG Ta patients, 1.7% and 0.4% experienced disease recurrence and progression, respectively. Total annual median costs of LG Ta surveillance and care increased 1.6-fold from $34,792 to $53,986 over the study period, with increased expenditures noted among those with disease recurrence ($53,909 and $76,669). Conclusions: Despite low rates of disease recurrence or progression, rates of surveillance testing increased during the study period. Annual cost of care increased over time, particularly among patients with recurrent disease. Efforts to improve adherence to current practice guidelines, with the focus on limiting overutilization of surveillance testing and overtreatment, may mitigate associated rising costs of care.

Duration and cost-effectiveness of hepatocellular carcinoma surveillance in hepatitis C patients after viral eradication

Successful treatment of chronic hepatitis C with oral direct-acting antivirals (DAAs) leads to virological cure, however, the subsequent risk of hepatocellular carcinoma (HCC) persists. Our objective was to evaluate the cost-effectiveness of biannual surveillance for HCC in patients cured of hepatitis C and the optimal age to stop surveillance. We developed a microsimulation model of the natural history of HCC in individuals with hepatitis C and advanced fibrosis or cirrhosis who achieved virological cure with oral DAAs. We used published data on HCC incidence, tumor progression, real-world HCC surveillance adherence, and costs and utilities of different health states. We compared biannual HCC surveillance using ultrasound and alpha-fetoprotein for varying durations of surveillance (from 5 years to lifetime) vs. no surveillance. In virologically cured patients with cirrhosis, the incremental cost-effectiveness ratio (ICER) of biannual surveillance remained below $150,000 per additional quality-adjusted life year (QALY) (range: $79,500-$94,800) when surveillance was stopped at age 70, irrespective of the starting age (40-65). Compared with no surveillance, surveillance detected 130 additional HCCs in 'very early'/early stage and yielded 51 additional QALYs per 1,000 patients with cirrhosis. In virologically cured patients with advanced fibrosis, the ICER of biannual surveillance remained below $150,000/QALY (range: $124,600-$129,800) when surveillance was stopped at age 60, irrespective of the starting age (40-50). Compared with no surveillance, surveillance detected 24 additional HCCs in 'very early'/early stage and yielded 12 additional QALYs per 1,000 patients with advanced fibrosis. Biannual surveillance for HCC in patients cured of hepatitis C is cost-effective until the age of 70 for patients with cirrhosis, and until the age of 60 for patients with stable advanced fibrosis. Individuals who are cured of hepatitis C using oral antiviral drugs remain at risk of developing liver cancer. The value of lifelong screening for liver cancer in these individuals is not known. By simulating the life course of hepatitis C cured individuals, we found that ultrasound-based biannual screening for liver cancer is cost-effective up to age 70 in those with cirrhosis and up to age 60 in those with stable advanced fibrosis.

The role of the electrocardiogram in the recognition of cardiac transplant rejection: A systematic review and meta-analysis.

BackgroundIn cardiac transplant recipients, the electrocardiogram (ECG) is a noninvasive measure of early allograft rejection. The ECG can predict an acute cellular rejection, thus shortening the time to recognition of rejection. Earlier diagnosis has the potential to reduce the number and severity of rejection episodes.MethodologyA systematic literature review was conducted to identify and select the original research reports on using electrocardiography in diagnosing cardiac transplant rejection in accordance with the PRISMA guidelines. Studies included reported sensitivity and specificity of ECG readings in heart transplant recipients during the first post‐transplant year. Data were analyzed with Review manager version 5.4. p‐value was used in testing the significant difference.ResultsAfter the removal of duplicates, 98 articles were eligible for screening. After the full‐text screening, a total of 17 papers were included in the review based on the above criteria. A meta‐analysis of five studies was done.ConclusionIn heart transplant recipients, a noninvasive measure of early allograft rejection has the potential to reduce the number and severity of rejection episodes by reducing the time and cost of surveillance of rejection and shortening the time to recognition of rejection.

The economic impact of circulating tumor-tissue modified HPV DNA for the post-treatment surveillance of HPV-driven oropharyngeal cancer: A simulation

PurposeFollowing treatment of HPV-driven oropharynx cancer, surveillance nasopharyngoscopy and imaging are often performed but are expensive and frequently ineffective. A novel plasma circulating tumor-tissue modified viral HPV DNA (TTMV-HPV-DNA) assay accurately detects recurrences. We modeled the cost of the new assay. MethodsWe designed and validated a partitioned survival model which replicated the results of the RTOG 1016 study and calculated cumulative surveillance costs from the payer’s perspective. Two strategies were considered: a standard of routine endoscopy with imaging as needed and an alternative strategy which omitted scopes and imaging but obtained serial TTMV-HPV-DNA samples. No difference in effectiveness (QALY or LY) was assumed in the base case. A 5-year horizon was used, costs were reported in 2020 U.S. dollars discounted by 3%. Seven scenarios tested model assumptions and practice variation. Deterministic and probabilistic sensitivity analyses assessed parameter uncertainty. ResultsIn the base case, at the list TTMV-HPV-DNA price, the cumulative cost of surveillance was $11,674 for the standard strategy and $20,756 for the TTMV-HPV-DNA strategy (+$9082 over 5 years). Probabilistic sensitivity analysis demonstrated the cost difference ranged from $4917-$12,047. The TTMV-HPV-DNA strategy was most likely to be either cost saving or cost-effective if future data demonstrate small improvements in quality or quantity of life (approximately 33 quality-adjusted life-days), if the assay reduces utilization of imaging, and if the periodicity of TTMV-HPV-DNA draws could be reduced from that on clinical trials. ConclusionsThis data informs providers seeking to design more accurate, accessible, and economical post-treatment surveillance strategies.

Using anti-theft tracking devices to infer fishing vessel activity at sea

Quantifying accurately human impacts on marine ecosystems is key to healthy oceans. While fish production from wild stocks has plateaued since the 1980 s, those estimates are primarily drawn from large-scale commercial fisheries, whose boats are routinely monitored using a suite of sophisticated equipment to ensure compliance. Smaller vessels, however, especially in developing countries, have not been so rigorously scrutinised due to their sheer number and the associated high surveillance cost. This study investigated the viability of using low-cost anti-theft devices to detect spatio-temporal patterns of fishing activity in the small- to medium-scale snapper fishery of Indonesia. SPOT Trace® GPS tracking units (SPOT, LLC) were deployed on a voluntary, participatory basis, on 130 deep water fishing boats ranging from 1.5 to 29 m in length. GPS data were subsequently analysed through a port identification and trip segmentation algorithm, before using spatial clustering to automatically identify positions likely associated with fishing events. Through this procedure, we identified a total of 2650 fishing trips, whose durations ranged from 4.3 h to 55.3 days. Fishing occurred primarily near vessels’ home ports, but also offshore in the Jawa Timur province, and in the Timor and Arafura Sea near the Australian Economic Exclusion Zone (EEZ). Adopting this technology as a low-cost alternative to traditional VMS could greatly empower monitoring agencies through surveillance of a previously poorly documented stratum of the commercial fishing sector, and result in better long-term management of fish stocks and marine resources.

Threat of Xylella fastidiosa and options for mitigation in infected plants

Abstract The bacterial pathogen Xylella fastidiosa continues to threaten agricultural production of many different crops around the world, with significant economic burden from crop loss, disease management, and surveillance costs. In addition to direct economic consequences, plant diseases caused by X. fastidiosa have had significant societal impacts in the most affected regions. Although X. fastidiosa infects long-term perennial crops and landscape plants, there has never been a truly effective treatment for plants once they become infected. This review discusses the threat of X. fastidiosa to agriculture, landscapes, and global commerce, in addition to the most recent progress in treatment for X. fastidiosa in infected plants. Current disease mitigation options include nutritional, chemical, biocontrol, and plant resistance-based strategies, with the potential to develop combined management approaches. Overall, several strategies are promising for disease suppression but there is still opportunity for innovation, especially in treatment approaches that can be administered systemically by soil or foliar spray routes. Prevention of severe disease outcomes and crop loss, and the ability to suppress pathogen populations and reduce transmission without heavy reliance on insecticides would have significant economic and environmental benefits.

Active Surveillance of Low-Risk Papillary Microcarcinoma of the Thyroid in Indian Scenario: Are we Ready for it? A Narrative Review.

Papillary microcarcinoma (PMC) is defined as papillary thyroid carcinoma(PTC) measuring≤1cm, irrespective of the presence or absence of the high‑risk features. PMCs without any high‑risk features referred to as the low‑risk PMCs are generally indolent, and most of them remain latent without progression or with very slow progression. Active surveillance(AS)(observation without immediate surgery) could identify the small minority of PMCs that progress and rescue surgery for these PMCs should be effective resulting in no influence on the patients’ prognosis than performing immediate surgery which might result in more harm than good due to associated morbidity. Hence, with proper patient selection, organization, and patient counseling, AS has the potential to be a long‑term management strategy for patients with PMC. The recent update of the American Thyroid Association guidelines(2015) incorporated AS as an option within the management protocol of PTC, making it a considerable rather than an experimental treatment option. The cost for immediate surgery is higher than the medical costs of AS for 10years in most scenarios. Developing countries like India may have certain limitations such as lack of understanding, financial constraints, and lack of adequate radiology services, hence we propose additional recommendations along with standard surveillance strategy.

Real Time Threat Assessment of Truck Cargos Carrying Dangerous Goods for Preventing Terrorism Attacks on Neighboring Critical Infrastructures

Critical infrastructures are assets of invaluable importance, essential for the whole world. Since they serve core functions of our societies, they often become targets of terrorists. Many critical infrastructures are vulnerable, due to their short distance from public roads and in the past years, several vehicle-bomb incidents have been recorded. This paper focuses on the case of truck-bombs, which can either be created from scratch, or terrorists can easily hijack truck cargos carrying dangerous goods and turn them into bombs. The latter are typically called ADR truck cargos, according to the respective agreement of the 30th of September 1957, concerning the international carriage of dangerous goods by road. The proposed scheme performs threat assessment of neighboring critical infrastructures, aiming at preventing explosions of truck-bombs. To do so, each crucial point of a critical infrastructure is initially associated with a level of importance. Next, three scenarios are analyzed: (a) single-attack single-infrastructure, (b) multiple-attack single-infrastructure, and (c) multiple-attack multiple-infrastructure. To reduce computational complexity, the third scenario is simplified to one of the two other scenarios, by introducing a novel fusion technique for the non-overlapping segments of the Voronoi tessellation. By this way, an area of threat assessment is estimated for each critical infrastructure. Then, the threat level is assessed in real time by an innovative algorithm, which: (a) estimates the impact of multiple consecutive explosions, (b) uses five adapted threat levels and (c) introduces multiple criteria and minimum classification conditions based on the number of crucial points and their levels of importance. Extensive real world experimental results and comparisons to other works, exhibit the pros and cons of the proposed scheme. In particular the proposed scheme improves: (a) computational time by 74.5%, compared to [69], (b) threat notification time by 86.9% compared to [70] and (c) estimated surveillance cost by 98.6% compared to [71].

Cost and clinical benefit of imaging surveillance after treatment for breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)

Recent UK guidelines recommend that surveillance imaging should not be offered to patients who have undergone treatment for breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) unless clinically indicated. The aim of this study was to explore the evolving practice at a tertiary referral unit and quantify the direct economic costs (DEC) associated with post-treatment BIA-ALCL routine radiological surveillance prior to adoption of the guidelines. Eleven patients were treated for BIA-ALCL between 2015 and 2020. At a median follow-up of 38 months (IQR 12–47) there were no local or distant relapses. Two patients did not have any radiological surveillance and 1 had follow-up elsewhere. The remaining 8 patients had a combination of positron emission tomography/computed tomography (PET/CT) (n = 10), CT (n = 2), breast ultrasound (n = 6), mammogram (n = 4) and breast magnetic resonance imaging (MRI) (n = 1) as routine imaging follow-up not guided by clinical concerns. Total cost of imaging was £10,396 (€12,257) with a median cost of £1953 (€2304) per patient [IQR £526-2029 (€621-2394)]. This cost could have been saved based on current guidelines recommending no routine surveillance for asymptomatic patients.